Research Evaluating the Use of Cannabinoids in a Palliative Cancer Care Setting
Emotional Distress and Quality of Life Research
In addition to the debilitating physical symptoms experienced by advanced cancer patients, these individuals must also cope with prognostic uncertainty and terminal diagnoses. This poses an immense psychological burden for patients. In fact, depression can affect up to 20% of cancer patients (Pitman, BMJ, 2018), which far exceeds the prevalence of 7% in the general population (NIMH Statistics). Panic attacks are also twice as common among cancer patients, with up to 24% experiencing clinically significant anxiety symptoms (Brintzenhofe-Szoc, Psychosomatics, 2009; Rasic, Psycho Oncology, 2008). Nonetheless, the vast majority (73%) of these patients do not receive effective psychiatric care (Pitman, BMJ, 2018).
There is some preliminary evidence to suggest that cannabis and its derivatives may improve psychosocial distress and overall quality of life in some patients. In one retrospective and one observational study, medical marijuana and nabilone, respectively, were shown to reduce anxiety and overall distress in advanced cancer patients (Seibert, J Clin Oncol, 2018; Maida, J Support Oncol, 2008). Additionally, one prospective, single center study demonstrated that advanced cancer patients using medical marijuana reported a 70% improvement in general well-being in addition to improvement in other cancer-related symptoms (Waissengrin, J Pain Symptom Manage, 2015). While these findings are encouraging, it should be noted that other studies have shown cannabinoids to have little to no effect on emotional or overall well-being (Whiting, JAMA, 2015; Birdsall, Curr Oncol Rep, 2016). It is possible that the effects of cannabinoids may vary between cancer types. For instance, medical marijuana was shown to be quite successful in a population of individuals with head and neck cancers. These patients experienced substantially less anxiety, depression, fatigue, and cancer-related pain (Zhang, JAMA Otolaryngol Head Neck Surg, 2018). Future research may benefit by evaluating various types of cannabinoids and the impact on specific patient populations.